NUR 265 EXAM 1 SPRING 2024/2025 ENRICHMENT Galen College

NUR 265 EXAM 1 SPRING 2024 ENRICHMENT

AKI - stages and interventions
s/s: anuria, low output,  systolic BP,  PP, orthostatic hypotension, thirst,  blood
osmolarity; change in fluid balance, new sediment in urine (smoke or red color), foul
smelling. Report OP < 30 mL/hr for 2 hrs or dark amber urine.

Stage 1:
Serum Creatinine: 1.5-1.9 x baseline or  0.3 mg/dL  over 48 hrs
Urine OP: <0.5 mL/kg/hr for 6-12 hrs

Stage 2:
Serum creatinine: 2.0-2.9 x baseline
Urine OP: <0.5 mL/kg/hr for  12 hr

Stage 3:
Serum creatinine: 1.0 x baseline or  in crea. To  4.0 mg/dL
Or initiation of renal replacement therapy
Or in patients <18 yrs,  in eGFR to <35 mL/min/1.73mm
Urine OP: anuria lasting for  12 HR
Or <0.3 mL/kg/hr for > 24 hrs

Phases:
1. Onset – trauma/injury
2. Oliguria – min. urine
3. Diuretics – a lot of urine
Measure I/O
Fluid electrolyte shift
Continue to perfuse kidneys
4. Recovery - 6 months – 1 yr

Azotemia: retention of nitrogenous waste in blood

Arterial blood gas; indications for obtaining an ABG; normal values for
CO2, Pa02, and Bicarb:
Indications for ABG: AMS/Respiratory status
Normal ABG values:
pH 7.35 – 7.45 (acid – base)
C02 35 – 45 (base – acid)
HC03 22 – 26 (acid – base)
Pa02 80 – 100 (problem = < 80)

Drugs that damage the kidneys Dietary guidelines for CKD patients:
Abx (mycins- vancomycin, gentamycin, etc. PEAK & TROUGH)
NSAIDS, acetaminophen, Metformin, Contrast Dye
(hold Metformin 48 hrs before giving contrast dye) need to pre/post fluid bolus patient
Lowest dose of contrast medium
Metformin + Contrast dye = NO

CKD diet:
 low protein, mod carb, fluid restriction, Na restriction (2G daily); K restriction
 add phosphate binder to every meal/snack;

,  iron supplement; iron rich foods;
 vitamins & water soluble vits.
 Ca (careful about what kind of Ca they take in), Vit D supplement
monitor all serum levels; depends on wt. gain & BP

How do CKD patients look and smell?
Musty, edematous, uremia (uremic frost); pruritus

Hemodialysis: process, expected outcomes, patient signs/symptoms to
expect after dialysis, concerning signs/symptoms after dialysis:
 Weigh patient before/after
 Feel the thrill, hear the bruit – monitor AV Fistula (do nothing to it)
 Serum electrolytes
 On heparin during dialysis
 Elevated temp after dialysis – dialysate warms blood
 Risk for bleeding
 BP low during dialysis – slow down/Trendelenburg patient

Disequilibrium syndrome – AMS, h/a, n/v; low BP;  P

Peritoneal dialysis patient:
aseptic technique,  protein; prevent peritonitis
Warm dialysate (not in microwave)
1. Instill – 1-3 L; clamp
2. Fill -
3. Dwell – semi fowler/supine position
4. Drain – look for cloudiness, monitor for peritonitis (cloudy drainage, rigid, call dr)
*rigid abd = priority patient
**going slow in, going slow out – reposition patient

Pancreatitis: dietary guidelines, labs, expected signs/symptoms,
concerning signs/symptoms
 Pancreatic enzymes activating prematurely
Diet – mod-high carb, avoid caffeine/alcohol/spicy foods ;
Pancreatic enzymes replacement therapy (PERT) w/ meals
  amylase, lipase, trypsin; ALT/AST, BGL, WBC, Bili
 Hypocalcemia – trousseau, chvostek’s sign

S/S: abd pain, RUQ, sudden onset pain, decrease/absent bowel sounds(Possible ileus)
Cullen’s sign/Turners sign; generalized jaundice; rigidity
 hypotensive, tachycardia = pancreatic hemorrhage
TX: NPO, IV fluid; medications – dilaudid – IV ABX

Paracentesis:
 V/S, Void, height, weight, HOB elevated
 Measure drainage, record, document characteristics
 If they lost weight = GOOD
 Apply dressing to site; look for leakage

Cirrhosis: dietary guidelines, emergency complications, expected
signs/symptoms of hepatic encephalopathy, medications for management
of the condition:

,  PT/aPTT = prolonged
  AST/ALT & ammonia
 Bilirubin – total; conjugated(direct); unconjugated (indirect)
 GGT
 Thrombocytopenia ( plt)
 Hematemesis/melena
 Fatigue,  in weight change, GI sx (anorexia/vomiting)
 ABD pain & liver tenderness
 Jaundice, icterus; Dry skin; Pruritus; Rashes; Petechia; Ecchymoses
 Warm & bright red palms of hand
 Spider angiomas; ascites
 Peripheral dependent edema of extremities and sacrum
 Vit def (fat-soluble – A, D, E, K)
 Fector hepaticus – distinctive breath odor/fruity/musty
 Amenorrhea & Asterixis (coarse tremor – hand flapping)

S/S – hepatic encephalopathy:
 sleep disturbance, mood disturbance, mental status change, speech problems.
Reversible w/ early intervention
 Later neuro sx – AMS, impaired thinking process; neuromuscular problems

Portal HTN – look out for peritonitis, esophageal varices, bleeding, ascites,
splenomegaly, prominent abd veins, hemorrhoids

Management:
Diet:
 High carb, mod fat, high protein
 Low Na, Fluid restriction
 Late stage IV vits – thiamine, folate, multivitamin

Medications:
Diuretic (spironolactone & furosemide combination diuretic therapy)
Nonselective BB (propranolol) & PPI
Vasoactive drugs – octreotide acetate & vasopressin ( portal pressure &
Secretion)
Lactulose; PRBCs, FFP, Dextran, Albumin, Plts.
Nonabsorbable abx if lactulose does not help/not tolerated (do not give
Lactulose & nonabsorbable abx together)
ABX - Neomycin sulfate, rifaximin (broad spectrum abx) (ST USE!!) (LT = kid.
Toxicity)
Thiamine & benzos  if pt is @ r/f alcohol w/drawal
SSRI (sertraline) for pruritus


Restrict: opioid analgesics, sedatives, barbiturates.
Fat-soluble vitamins, excessive iron supplements, Niacin
No acetaminophen, NSAIDS, alcohol, drugs
No straining, coughing, sneezing, no NG tube

TX for Varices:
Balloon tamponade, esophageal stents; shunting procedures; second
Endo Procedure, EST, EVL banding, TIPS
Lactulose – poop out ammonia